Spring Break Paperwork Packet

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Camper Information

Camper Name(Required)

First Last

Camper Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Camper age(Required)

Current Grade(Required)

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

Registered Camps

Camps for your child that you have already registered and paid for. Select all that apply.

3/25 Spring Break Mini-Camp: Treasure Hunt

3/26 Spring Break Mini-Camp: Hooked on Fishing

3/27 Spring Break Mini-Camp: Outdoor Survivor

Parent/Guardian Name(Required)

First Last

Parent/Guardian Phone Number(Required)

Parent/Guardian Email(Required)

Emergency Contacts

Fill in emergency contact information – can be a parent/guardian, relative, family friend, etc. You may include the same parent that you previously listed above in the emergency contact list if applicable.

Emergency Contact #1 – Name(Required)

First Last

Emergency Contact #1 – Relationship to Child(Required)

Emergency Contact #1 – Phone Number(Required)

Emergency Contact #2 – Name(Required)

First Last

Emergency Contact #2 – Relationship to Child(Required)

Emergency Contact #2 – Phone Number(Required)

Emergency Contact #3 – Name

First Last

Emergency Contact #3 – Relationship to Child(Required)

Emergency Contact #3 – Phone Number(Required)

Camper Medical and Wellbeing History

Medical Conditions(Required)

Complete the following chart by selecting Yes/No. Please comment on any “Yes” answers below.

	Yes	No
Asthma or other respiratory problems
Gastrointestinal disturbances
Diabetes
High blood pressure
Bleeding or blood abnormalities
Neurological problems or epilepsy
Dizziness or fainting episodes
Migraines
Heart problems
Disorders of urinary or reproductive tract
Knee, hip or ankle injuries and/or surgeries
Shoulder, arm, or back injuries and/or surgeries
Head injury
Child greatly affected by heat
Child gets cold easily
Stroke

Use this space to expand on any "Yes" responses above.

Other Medical/Health Consideration(Required)

Complete the following chart by selecting Yes/No. Please comment on any “Yes” answers below.

NOTE: Venture Outdoors staff will NOT administer medication. Contact our Camp Coordinator (Lisa@VentureOutdoors.Org) if your child needs medication during program time or will need to carry their own epi-pen/inhaler.

	Yes	No
Any other allergies, such as food, medication or seasonal?
Will child carry an inhaler or epi-pen?
Does child have special dietary needs, such as vegan/vegetarian?
Does child have muscle spasms?
Is child taking medication?
Will child require medication during our program hours?

Use this space to expand on any "Yes" responses above.

Include information on allergies, rescue inhalers, side effects of any medications, etc. NOTE: Venture Outdoors Staff will NOT administer medication. Please contact Camp Coordinator (Lisa@VentureOutdoors.Org) if your child will need medication during program time or will be carrying an epi-pen/inhaler.

Child Wellbeing(Required)

Complete the following chart by selecting Yes/No. Please comment on any “Yes” answer below.

	Yes	No
Does your child have a mobility impairment?
Is your child sensitive to sights, sounds or other sensations?
Has your child ever been treated for attention deficit disorder (ADD) or attention deficit/hyperactivity disorder (AD/HD)?
Has your child ever been treated for emotional or behavioral difficulties or an eating disorder?
Has your child experienced a significant life event that continues to affect the child’s life?
Is your child uncomfortable with water?
Is English a 2nd language for your child? If yes, please indicate primary language in box below.

Expand on any "Yes" responses above and list any medical, physical or emotional medical concerns that are not mentioned above and provide ways we can accommodate and support your child.

Sunscreen/Bug Spray Permission(Required)

I give permission for Venture Outdoors staff to assist my child in applying sunscreen and bug spray as needed.

Yes

Is there anything else you would like us to know about your child's wellbeing or that you would like staff to know about working with your child?

Acknowledgment(Required)

By selecting this box, I hereby acknowledge that the above information is true and accurate to the best of my knowledge.

Today's Date(Required)

Month

Day

Year

Signature(Required)

Camper Release Information

The pick-up window for camps is between 2:45-3PM daily. A late fee of $1/minute/child will be charged for late pick-ups beginning at 3:01PM.

Release List(Required)

List the individuals who may pick up the camper at the conclusion of each day. Please include yourself if you’ll be picking them up. Note: any individual picking up the camper will be asked to show photo ID.

Name

Phone #

Relationship to Camper

Camper Contract

At Venture Outdoors, we strive to create meaningful and healthful experiences for children in the outdoors. In order to do so, we foster an environment where safety and wellbeing are of utmost importance. Please review and discuss the following guidelines with your child prior to the program. We will review this contract during the program and have students sign their understanding and agreement.

Behavior Guidelines(Required)

We understand and agree to the Behavior Guidelines.

I will treat myself, others, and equipment with respect.

I will speak highly of my fellow peers and Venture Outdoors staff.

I will keep my hands to myself.

I will set a positive example for others because I am a role model.

I will always remain with my group and Venture Outdoors staff at all times.

I will ask Venture Outdoors staff for their permission to use the restroom, get a drink of water, or go elsewhere.

I agree to accept the instructions that are given to me by Venture Outdoors staff and follow them the first time.

Conduct Violation(Required)

We understand and agree to the Conduct Violation Code.

If I act in such a way that does not follow the behavior guidelines, I understand that there may be consequences for my actions, including verbal warnings, parental contact, or suspension/dismissal from the program. My parent may need to come pick me up from the program in the event that I need to be sent home in the middle of a program.

I will seek to understand why I acted the way I did and work with Venture Outdoors staff to make better behavior choices.

Behavior Response Guidelines(Required)

We have reviewed and understand the behavior responses guidelines. We understand no refunds will be issued in the event of suspension or termination from the program.

We want to make summer camp a fun and enjoyable space for all children and staff. We expect campers to treat themselves, fellow campers and staff, and equipment with respect and care. Below outlines our team’s behavior response actions. While every situation is different, these are the guidelines we follow and will work with the child and parent on a case-by-case basis. No refunds will be issued for camper suspensions or terminations.

Level 1 Behaviors

Level 1 behaviors warrant the following responses in order if unresolved:
1. Verbal warning
2. Parent communication
3. Parent/child meeting with staff
4. Suspension (1-day)
5. Termination

Behaviors:
• Misuse of food or equipment
• Littering
• Excessive touching/personal space violation
• Not following directions
• Teasing (name calling, isolation)
• Profanity
• Lying/dishonesty
• Disrespecting staff or others
• Disregarding cell phone/electronics policy

Level 2 Behaviors

Level 2 behaviors warrant the following responses in order if unresolved:
1. Parent communication and suspension (1 day)
2. Termination

Behaviors:
• Physical aggression (hurting self, shoving/slapping, kicking furniture or equipment)
• Verbal aggression (yelling/screaming)
• Bullying (repeated verbal, physical targeted behavior)
• Out of bounds (leaving the group/property)
• Stealing

Level 3 Behaviors

Level 3 behaviors results in immediate parent contact and termination from camp.

Behaviors:
• Threats
• Fighting
• Vandalism/destruction of property
• Having drugs, alcohol, knife, gun or other weapon

Parent Signature(Required)

We agree to the Behavior Guidelines and Conduct Violation Policy.

As a parent, I have read and understand this conduct contract. I have discussed these expectations with my child, who has agreed to follow them while in the program. I understand that I will not receive a refund if my child is suspended/dismissed from the program for violation of this contract.

Driving Youth

Consent(Required)

I give permission for my child to be shuttled by Venture Outdoors staff in a Venture Outdoors company vehicle.

On occasion, we may shuttle campers in a company vehicle to reach locations within the park that may be too far for hiking or biking. We will notify you ahead of time when we plan on shuttling the campers. Campers are expected to follow the same behavior guidelines outlined in the camper contract.

Acknowledgement & Assumption of Risk Form

Consent(Required)

I will complete an Acknowledgment & Assumption for Risk for my child.

In addition to this paperwork packet, you must complete a Venture Outdoors Acknowledgement & Assumption of Risk Form for your child. Venture Outdoors staff will send this form to you to complete via a digital link.

Phone

2024 Spring Break Mini-Camp Wellbeing Packet

Camper Information

Emergency Contacts

Camper Medical and Wellbeing History

Camper Release Information

Camper Contract

Driving Youth

Acknowledgement & Assumption of Risk Form